0920T Medicaid reimbursement rates by state
Outpatient hospital services (fee schedule). 8 state Medicaid programs publish a fee-for-service rate for 0920T. Rates run from $41.76 in Iowa to $3,639.30 in New Mexico, with a median of $1,628.79.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 8
- Median rate
- $1,628.79units vary by state
- Highest
- $3,639.30New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
0920T rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $3,639.30since 2025-01-01 | — | — | Plans must pay at least this | — | OPPS Codes (NM Medicaid Hospital Outpati |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $2,091.10since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2026 ASC Fee Schedule |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $2,042.30since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid ASC fee schedule (2026ASCFee |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $1,987.59since 2026-01-01 | — | — | Not classified | — | Arkansas Medicaid CY2026 Ambulatory Surg |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $1,269.99since 2025-01-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Amb Surgical Cente |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $1,089.83since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $41.76since 2026-01-01 | — | — | Not classified | — | CMAP Addendum B - OPPS Payment Type by P |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $41.76since 2026-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid Addendum B (CY 26-Janaury) |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 0920T?
It depends on the state. Of the 8 states with a published fee-for-service rate, the median is $1,628.79. New Mexico pays the most ($3,639.30) and Iowa the least ($41.76).
Which state pays the highest Medicaid rate for 0920T?
New Mexico, at $3,639.30, effective 2025-01-01.
Do managed-care plans pay the same rate for 0920T?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.